AB0271 PREDICTIVE FACTORS OF CARDIAC IMPAIRMENT IN RHEUMATOID ARTHRITIS
Authors: M. Brahem, R. Sarraj, H. Ibn Hadj Amor, A. Ben Salem, S. Kraiem, R. Rouabhia, E. Hmaier, H. Hachfi, Y. Mohamed
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> In view of the insidious and serious nature of cardiac involvement in rheumatoid arthritis (RA), systematic screening for these diseases and the identification of risk factors is of paramount importance in order to preserve and improve patients' quality of life and life expectancy. <h3>Objectives</h3> The objective of our study is to determine the predictors of cardiac involvement. <h3>Methods</h3> We performed a cross-sectional study conducted in Taher Sfar Hospital, Mahdia, Tunisia. Each patient underwent a transthoracic echocardiography (TTE) coupled with Strain technique. The comparison between a quantitative variable and a qualitative variable was made by the "Student's t" test if the quantitative variable follows the normal law, if not, the "Mann-Whitney" test was used. The multivariate study was done by binary logistic regression. A p value &lt;0.05 was considered statistically significant. <h3>Results</h3> Seventy-two patients with RA were included in our study. There was a clear female predominance with a sex ratio of 0.07. The mean age of RA patients was 52.9 ± 11.72 years [21-75 years]. The mean duration of disease progression was 12.4 ± 9.9 years [6 months-40 years]. The means of DAS 28 (CRP), DAS 28 (ESR) and HAQ score were respectively 3.4 ± 1.4 [1.2-6.7]; 3.9 ± 1.4 [1.4-7.4] and 0.9 ± 0.7 [0-2.5]. 51.4% of patients had an increased ESR and 37.5% of cases had an increased CRP (CRP&gt;6). Corticosteroid therapy was used in 94.4% of patients with a mean duration of 5.9 ± 5.2 years [1-20 years], methotrexate (MTX) in 98.6% of patients with a mean duration of 8.1 ± 6.9 years [1-40 years] and biotherapy in 19.4% of cases. Rheumatoid factor was positive in 51.7% of cases and ACPAs were positive in 73.3% of cases. TTE revealed abnormalities in 58 patients (80.6% of cases). Echocardiographic impairments were dominated by valvular involvement (45.8%), followed by subclinical left ventricular myocardial damage assessed by the Global Longitudinal Strain (GLS) method (37.5%), Left ventricular diastolic dysfunction (36.1%), Left ventricular hypertrophy (22.2%), pericardial effusion and pulmonary arterial hypertension (2,8%). The bivariate analysis found a statistically significant relationship between echocardiographic damage and disease activity (p&lt;0.01), the number of painful joints (p&lt;0.01), the functional impact of the disease (HAQ) (p=0.01), the importance of the CRP level (p&lt;0.01) and the use and dose of corticosteroid therapy (p=0.02; p=0.01). The multivariate study showed only one significant association between echocardiographic involvement and disease activity (p = 0.03; OR = 1.8; CI [1.04-3.3]). <h3>Conclusion</h3> Our study proved an association between cardiac involvement and disease activity. Therefore, early and appropriate management of RA may decrease the risk of cardiac impairment. <h3>References</h3> [1] Hanvivadhanakul P, Buakhamsri A. Disease activity is associated with LV dysfunction in rheumatoid arthritis patients without clinical cardiovascular disease. Adv Rheumatol (London, England) 2019;59:56. [2] Thadani U, Iveson JM, Wright V. Cardiac tamponade, constrictive pericarditis and pericardial resection in rheumatoid arthritis. Medicine (Baltimore) 1975;54:261–70. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.